Hodgkin Disease Survivors Face Higher Risk for Stroke Later in Life

Patients surviving childhood Hodgkin's disease suffer Strokes later in life at rates about four times that of the general population, UT Southwestern Medical Center researchers have found.

Principal investigator Dr. Daniel Bowers, assistant professor of pediatrics, and other UT Southwestern researchers identified the link using patient information from a national database of long-term childhood cancer survivors. The study, which appeared in the Journal of Clinical Oncology, is available online.

"We were surprised. We knew there was increased risk of a second cancer - usually breast cancer - and increased risk of heart failure, but Stroke was unexpected," said Dr. Bowers.

Although doctors cure about 70 percent of pediatric outpatients with cancer, little research had linked strokes later in life to cancer. Testing that hypothesis on all survivors of childhood cancer was too impractical, so the UT Southwestern research team narrowed the field to survivors of Hodgkin's disease, a type of lymphoma that's the second-most common form of childhood cancer.

Hodgkin's lymphoma is a malignancy (cancer) of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow.

Causes, incidence, and risk factors

The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to adjacent lymph nodes and later may spread outside the lymph nodes to the lungs, liver, or bone marrow.

The cause is not known. The incidence is 2 in 10,000 people. Hodgkin's lymphoma is most common among people 15 to 35 and 50 to 70 years old.

More information: Hodgkin's disease

"The goals are changing to more than just curing the child of cancer," Dr. Bowers said. "They are to evaluate and reduce the long-term side effects. It's been well-established that childhood cancer survivors have several well-described long-term side effects, including second cancers, learning problems, growth problems and heart damage."

UT Southwestern is a member of the Childhood Cancer Survivor Study, a national consortium tracking the long-term effects of cancer survivors. Children's Medical Center Dallas is also a member and contributed patients to the study. The National Institutes of Health-sponsored study involves 27 institutes and the statistical histories of some 20,000 childhood cancer survivors.

From that database, researchers identified 1,926 people who had survived Hodgkin's disease more than five years after being diagnosed between 1970 and 1986. Dr. Bowers and other researchers identified 24 survivors who later reported a and compared that to the siblings of cancer survivors, where only nine of more than 3,800 had suffered . The incidence of strokes - 83.6 per 100,000 person-years for survivors and 8.0 per 100,000 person-years for the control group - demonstrated that Hodgkin disease survivors were at significantly increased risk of suffering a .